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General NPI Number Information
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NPI Number | 1629851258
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Entity Type | Organization
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Legal Business Name | EMPOWERED FAMILY THERAPY SERVICES
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Dates
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Enumeration Date | 08/16/2023
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Last Update Date | 10/12/2023
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Provider Practice Location Address
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Address Line | 121 W MAIN ST STE G
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City | TURLOCK
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State | CA
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Zip | 95380-4845
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Country | US
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Telephone | 209-416-4866
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Fax |
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Provider Business Mailing Address
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Address Line | 121 W MAIN ST STE G
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City | TURLOCK
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State | CA
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Zip | 95380-4845
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Country | US
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Telephone | 209-416-4866
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Fax | 209-301-7817
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Authorized Official
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Title or Position | CEO
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Name | NATASHA NICHOLE CERRILLO
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Credential |
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Telephone | 209-416-4866
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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